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Cancer/COVID-19 Update: ‘Don’t Delay Screenings,’ Urges Oncologist

Cedars-Sinai Cancer-Tarzana Oncologist Johnny Chang, MD, Addresses the Latest Issues Facing Cancer Patients in the Age of COVID-19

As frightening as COVID-19 is to many adults and children, the prospect of catching the virus is especially harrowing for cancer patients. That’s because certain cancer treatments suppress the immune system, making patients vulnerable to opportunistic infections.

Additionally, as the pandemic continues its relentless march, many people at higher risk for cancer continue to delay preventive screenings out of fear of in-office doctor visits. The delay only makes those patients more vulnerable to later-stage diagnoses and worse outcomes.

Cedars-Sinai's Newsroom asked oncologist Johnny K. Chang, MD, medical director of Cedars-Sinai Cancer-Tarzana, to address new and ongoing issues facing cancer patients:

Newsroom: What is your advice to those who still are delaying cancer screenings because of COVID-19 fears?
JC: My most important advice is to not delay screenings. After six months of this pandemic, those requiring appropriate screenings should get them done. We know how to keep our patients safe during screenings, and recently published medical studies have highlighted the negative effects of putting off mammograms, prostate screenings and skin checks. If you have symptoms that could be cancer-related, call your physician now, today. My practice is seeing new cancer cases whose diagnoses were delayed, and some cases are presenting at later stages than they would have. Cancer typically cannot wait.

Newsroom: With flu season imminent, is there a special urgency for cancer patients to get vaccinations this year?
JC: Yes! We always encourage everyone, particularly our patients, to get flu vaccinations. Cancer patients do benefit from them, especially in light of COVID-19. Any type of respiratory infection, including from the flu, may increase the risk of death if the patient gets COVID-19. Because some cancer therapies suppress the immune system, the effectiveness of the flu vaccine is sometimes questionable. Nevertheless, it’s better to get some response than none. Patients should discuss the timing of a vaccine with their oncologist.

Newsroom: How can patients differentiate between cancer-treatment side effects and COVID-19/flu symptoms?
JC: It’s a difficult distinction sometimes because some symptoms overlap. For example, certain cancer treatments cause patients to lose their sense of taste, which also has been reported as a COVID-19 symptom. Some chemotherapies also may cause fever and even flu-like symptoms. Patients and their oncologists should discuss treatment side effects. Follow-up calls shouldn’t be delayed if patients experience, for example, fevers that last more than 24 hours following treatments or a prolonged loss of taste.

Newsroom: When a COVID-19 vaccine becomes available, should cancer patients get it? 
JC: I don’t know enough at this time to make a recommendation. When the vaccine is approved and data are available, oncologists should assess cancer patients individually and make decisions based on which treatments they’re taking, among other factors.

Newsroom: For patients still hesitant to make office visits, when is telemedicine appropriate for cancer patients, and when isn’t it?
JC: Video or phone appointments are fine to discuss treatment side effects or review test results, if nothing else has changed. If possible, new patients or those who need bloodwork should have an in-person visit. Patients who are having trouble breathing or feel very tired for a few days after treatment should see their oncologist at the office if an initial phone discussion does not lead to improvement. Remember that from the outset of the pandemic, all Cedars-Sinai facilities implemented patient-safety measures. Our offices have adapted to and adjusted them based on ongoing updates.

Newsroom: What is your advice to cancer patients desperate to have in-person contact with family and friends after months of isolation?
JC: Some cancer patients deal with steep psychosocial issues, such as isolation and depression, and need social contact. Patients should discuss with their oncologist the safety of family interactions. That’s especially true for immune-compromised patients: Under what circumstances are you meeting family members? Do you know the health status of those you’re seeing? Everyone should maintain distancing recommendations and wear face masks. If you go to a social gathering where others are not wearing masks or people are sick, it doesn’t matter whether you’re immune compromised or not — make a prompt exit.

Newsroom: Should cancer patients avoid markets and retail stores?
JC: Ideally, cancer patients undergoing treatment should avoid public places. However, patients who don’t have family or friends available to help with grocery shopping must make their own decisions about visiting stores. Those who venture out must make sure they’re well-protected with masks and hand sanitizer. They must be extremely careful in public places.

Newsroom: How important is exercise during cancer treatments, and is it OK to exercise outdoors?
JC: Exercise helps bring balance to lives disrupted by disease. Some of my patients say that exercise helps keep them going. I also have patients who haven’t left the house in six months. I encourage my patients to exercise in moderation. If you have a large backyard, walk around it as long as you can, avoiding exposure to others. If you’re not very immune suppressed, you may take long walks daily away from home. Wear a mask.

Newsroom: How can cancer patients get emotional support without risking exposure to COVID-19?
JC: A lot of remote supportive services are available through the Cedars-Sinai Patient and Family Support Program, in which Cedars-Sinai Cancer-Tarzana patients may participate. Services include psychiatric care; nutritional support; the Wellness, Resilience & Survivorship programs; plus a host of additional programs. We also offer our own social services and soon will have an onsite dietitian. These services are more important now than ever before.

Newsroom: As the pandemic grinds on, do you have hopeful words for cancer patients?
JC: Despite COVID-19, some things still must go on, including cancer treatments. COVID-19 is not a reason to wait for doctors’ visits and treatments. If patients need certain services or seek consultations but still feel unsafe, we will look for different options that will make you feel safe. Cancer patients can live good, balanced lives even while COVID-19 is out there. We’re here to help.

Read about breast cancer detection on the blog: Blindsided by Breast Cancer: A Patient’s Advice